Colistin: The revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections
Colistin: The revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections
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DOI：
10.1086/429323
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发表时间：
2005-05-01
影响因子：
11.8
通讯作者：
Kasiakou, SK
中科院分区：
文献类型：
--
作者：
Falagas, ME;Kasiakou, SK
多重耐药革兰氏阴性菌的出现和缺乏新的抗生素来对抗它们，导致了多粘菌素的复兴，多粘菌素是一类古老的阳离子环状多肽抗生素。多粘菌素B和多粘菌素E（粘菌素）是临床实践中使用的2种多粘菌素。在过去几年中，大多数多粘菌素的重新引入与粘菌素有关。多粘菌素对选定的革兰氏阴性细菌具有活性，包括不动杆菌属、铜绿假单胞菌、克雷伯氏菌属和肠杆菌属。几十年来，这些药物在世界各地广泛使用，供当地使用。然而，由于报告了常见和严重的肾毒性和神经毒性，除治疗囊性纤维化患者外，大多数国家与20年前相似，放弃了这些药物的胃肠外使用。最近对接受静脉注射多粘菌素治疗各种类型的严重铜绿假单胞菌和鲍曼不动杆菌感染（包括肺炎、菌血症和尿路感染）的患者进行的研究得出的结论是，这些抗生素具有可接受的有效性，并且毒性比旧研究中报告的毒性低得多。
The emergence of multidrug-resistant gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of polymyxins, an old class of cationic, cyclic polypeptide antibiotics. Polymyxin B and polymyxin E ( colistin) are the 2 polymyxins used in clinical practice. Most of the reintroduction of polymyxins during the last few years is related to colistin. The polymyxins are active against selected gram-negative bacteria, including Acinetobacter species, Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species. These drugs have been used extensively worldwide for decades for local use. However, parenteral use of these drugs was abandoned similar to 20 years ago in most countries, except for treatment of patients with cystic fibrosis, because of reports of common and serious nephrotoxicity and neurotoxicity. Recent studies of patients who received intravenous polymyxins for the treatment of serious P. aeruginosa and Acinetobacter baumannii infections of various types, including pneumonia, bacteremia, and urinary tract infections, have led to the conclusion that these antibiotics have acceptable effectiveness and considerably less toxicity than was reported in old studies.